Eric J. Woollen, vice president of managed care for Practice Partners in Healthcare, describes two situations where staying out-of-network may be an ambulatory surgery center's only option.
1. Surgery center unable to contract with health plan. In some markets, health plans may simply refuse to contract with your ASC. "If the health plan feels they have an adequate network for their beneficiaries, they simply close the network," Mr. Woollen says. "In these instances, out-of-network will be your only option."
2. Health plan's reimbursement rates are unsustainable. "When you have a firm understanding of your market, payor mix and case costs, you may determine that the in-network rates are simply too low," Mr. Woollen says. "If you went in-network, you'd be losing money every time you performed a case with that particular payor." If the incremental volume doesn't provide the necessary returns to justify the discounts or revenues, out-of-network again may be your only option.
Learn more about Practice Partners in Healthcare.
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